Many patients feel poorly prepared for discharge from rehabilitation, despite longer therapy phases¹. Training and increased awareness of self-management techniques for healthcare professionals built into their current mainstream clinical services could offer patients new opportunities to take control of their lives and return to functional independence; and with effective integration, the problem many patients face after discharge from rehabilitation2 could be addressed with confidence.
What is self management?
Self-management refers to the “active participation of a person in dealing with their own symptoms, treatments, physical and psychosocial consequences” associated with the consequences of a chronic illness; and because of the different recovery needs of patients, it is essential for these individuals to intervene to develop appropriate knowledge and skills to better cope with their health problems in daily life³. Patients with long-term illnesses spend 99% of their lives coping with their own illness; with no interactions from health care practitioners. When in need of constant family, community, or healthcare professional support, they are highly dependent and have severe restrictions on participation.
Self-management interventions (SMI)
There is good evidence in the literature that a self-management approach to health care works; and that self-management interventions (SMIs) designed for chronic conditions have shown a positive impact on quality of life, clinical outcomes and overall health care utilization⁴. SMIs are designed to empower individuals to manage their health more effectively; and engagement in SMIs is seen as key to promoting recovery and enabling improved health outcomes⁵. SMIs are preferred in resource-constrained environments (such as South Africa) because of their nature to improve self-efficacy and encourage individuals to manage their own symptoms, treatments, and lifestyle changes; as they enable and enable individuals to take responsibility for their own health care and rehabilitation and thus reduce the burden of care for the limited available community rehabilitation resources in the health sector⁶.
South Africa is in the process of rethinking its approach to health care and service delivery, according to the Western Cape Health Department’s Healthcare 2030 Road to Wellness⁷ report. with the main focus and vision for 2030 being on achieving a “people-centered approach”. This redesigned approach provides for a strengthening of the primary health care (PHC) service platforms, which also include community-based services – “A central tenet of the PHC philosophy is community participation in health, which means that the community takes responsibility and responsibility for one’s own health care on a personal level ”. As part of this process, the WCDOH is committed to promoting the need for “a philosophical and practical paradigm shift among health workers from health providers to health enablers / enablers” to encourage shared responsibility for increasing and maintaining wellbeing. This is important to eliminate the notion of dependency on health care providers and to foster individual / community capacity and responsibility for health and care for themselves and others ”⁷.
Development of self-management skills
However, in order to achieve effective self-management it is crucial that the individual is actively involved in learning several self-management skills³, such as: For example: goal setting, reflection, problem solving, use of resources, self-discovery, knowledge and decision-making. Using language to help develop the above self-management skills in our patients is one of the most important tools that we as healthcare professionals have; where the right wording and questions need to be asked to effectively facilitate and support the development of self-management. For example, when you assign a person to a challenging task that is ahead of them instead of giving them the solution to complete it, ask, “How? she Do you think you can overcome that? “; Critical thinking and problem solving are made possible and the right amount of support is offered through moderation.
The development of these skills also requires a degree of individual self-efficacy⁸, with self-efficacy affecting each of these skills; Hence, improving self-efficacy means improving self-management.
Dr. Ryan Groenewald is Practice Manager at [email protected], a partner of Medwell SA – The Home Health Care Specialists. For more information, visit www.physiotherapieathome.co.za or www.medwell.co.za
- Jones, F., Mandy, A. & Partridge, C. (2009). Change in self-efficacy in individuals after a first stroke: preliminary study of a novel self-management intervention. Clinical rehabilitation, 23(6), 522-533.
- Hale, L., Jones, F., Muligan, H., Levack, W., Smith, C., Claydon, L., … & Flannery, J. (2014). Developing the Bridges Self-Management Program for New Zealand Stroke Survivors: A Case Study. International Journal of Therapy and Rehabilitation, 21(8), 381-388.
- Lo, SHS, Chang, AM, Chau, JPC & Gardner, GE (2013). Theory-Based Self-Management Programs to Promote Recovery in Stroke Survivors: A Systematic Review. JBI Database of Systematic Reviews and Implementation Reports, 11(12), 157-215. Available at: http://www.joannabriggslibrary.org/jbilibrary/index.php/jbisrir/article/view/1056.
- de Silva, D. (2011). Helping people help themselves: A review of the evidence on whether it is worth supporting self-management. London: The Health Foundation. Available at: http://www.health.org.uk/sites/health/files/ HelpingPeopleHelpThemselves.pdf.
- Boger, EJ, Demain, S., & the latter, S. (2013). Self-Management: A systematic review of the measures of outcome used in self-management interventions for stroke. Disability and Rehabilitation Journal, 35 (17), 1415-1428.
- Lennon, S., McKenna, S. & Jones, F. (2011). Self-Management Programs for People After Stroke: A Systematic Review. Clinical rehabilitation, 27(10) 867-878.
- Ministry of Health of the Western Cape. (2014). Healthcare 2030: The Path to Wellbeing. Available at: https://www.westerncape.gov.za/assets/departments/health/healthcare2030.pdf.
- Riazi, A., Aspden, T. & Jones, F. (2014). Self-efficacy questionnaire after a stroke: A measure refined by Rasch for self-confidence after a stroke. Journal of Rehabilitation Medicine, 46(5), 406-412.